Provider Demographics
NPI:1386818805
Name:AUSTIN, WALTER JOHN (C PED)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOHN
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 LIEN RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3689
Mailing Address - Country:US
Mailing Address - Phone:608-242-9273
Mailing Address - Fax:
Practice Address - Street 1:4261 LIEN RD
Practice Address - Street 2:SUITE O
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3689
Practice Address - Country:US
Practice Address - Phone:608-242-9273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other